Recipes for Health: Cauliflower and Tuna Salad — Recipes for Health

Andrew Scrivani for The New York Times

I have added tuna to a classic Italian antipasto of cauliflower and capers dressed with vinegar and olive oil. For the best results give the cauliflower lots of time to marinate.

1 large or 2 small or medium cauliflowers, broken into small florets

1 5-ounce can water-packed light (not albacore) tuna, drained

1 plump garlic clove, minced or pureéd

1/3 cup chopped flat-leaf parsley

3 tablespoons capers, drained and rinsed

1 tablespoon fresh lemon juice

3 tablespoons sherry vinegar or champagne vinegar

6 tablespoons extra virgin olive oil

Salt and freshly ground pepper

1. Place the cauliflower in a steaming basket over 1 inch of boiling water, cover and steam 1 minute. Lift the lid for 15 seconds, then cover again and steam for 5 to 8 minutes, until tender. Refresh with cold water, then drain on paper towels.

2. In a large bowl, break up the tuna fish and add the cauliflower.

3. In a small bowl or measuring cup, mix together the garlic, parsley, capers, lemon juice, vinegar, and olive oil. Season generously with salt and pepper. Add the cauliflower and toss together. Marinate, stirring from time to time, for 30 minutes if possible before serving. Serve warm, cold, or at room temperature.

Yield: Serves 6 as a starter or side dish

Advance preparation: You can make this up to a day ahead, but omit the parsley until shortly before serving so that it doesn’t fade. It keeps well in the refrigerator for up to 5 days.

Nutritional information per serving: 188 calories; 15 grams fat; 2 grams saturated fat; 2 grams polyunsaturated fat; 10 grams monounsaturated fat; 10 milligrams cholesterol; 8 grams carbohydrates; 3 grams dietary fiber; 261 milligrams sodium (does not include salt to taste); 9 grams protein

Martha Rose Shulman is the author of “The Very Best of Recipes for Health.”

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Recipes for Health: Cauliflower and Tuna Salad — Recipes for Health

Andrew Scrivani for The New York Times

I have added tuna to a classic Italian antipasto of cauliflower and capers dressed with vinegar and olive oil. For the best results give the cauliflower lots of time to marinate.

1 large or 2 small or medium cauliflowers, broken into small florets

1 5-ounce can water-packed light (not albacore) tuna, drained

1 plump garlic clove, minced or pureéd

1/3 cup chopped flat-leaf parsley

3 tablespoons capers, drained and rinsed

1 tablespoon fresh lemon juice

3 tablespoons sherry vinegar or champagne vinegar

6 tablespoons extra virgin olive oil

Salt and freshly ground pepper

1. Place the cauliflower in a steaming basket over 1 inch of boiling water, cover and steam 1 minute. Lift the lid for 15 seconds, then cover again and steam for 5 to 8 minutes, until tender. Refresh with cold water, then drain on paper towels.

2. In a large bowl, break up the tuna fish and add the cauliflower.

3. In a small bowl or measuring cup, mix together the garlic, parsley, capers, lemon juice, vinegar, and olive oil. Season generously with salt and pepper. Add the cauliflower and toss together. Marinate, stirring from time to time, for 30 minutes if possible before serving. Serve warm, cold, or at room temperature.

Yield: Serves 6 as a starter or side dish

Advance preparation: You can make this up to a day ahead, but omit the parsley until shortly before serving so that it doesn’t fade. It keeps well in the refrigerator for up to 5 days.

Nutritional information per serving: 188 calories; 15 grams fat; 2 grams saturated fat; 2 grams polyunsaturated fat; 10 grams monounsaturated fat; 10 milligrams cholesterol; 8 grams carbohydrates; 3 grams dietary fiber; 261 milligrams sodium (does not include salt to taste); 9 grams protein

Martha Rose Shulman is the author of “The Very Best of Recipes for Health.”

Read More..

Online Banking Attacks Were Work of Iran, U.S. Officials Say

SAN FRANCISCO — The attackers hit one American bank after the next. As in so many previous attacks, dozens of online banking sites slowed, hiccupped or ground to a halt before recovering several minutes later.

Daniel Rosenbaum for The New York Times

James A. Lewis of the Center for Strategic and International Studies in Washington believes that recent online attacks on American banks have been the work of Iran.

But there was something disturbingly different about the wave of online attacks on American banks in recent weeks. Security researchers say that instead of exploiting individual computers, the attackers engineered networks of computers in data centers, transforming the online equivalent of a few yapping Chihuahuas into a pack of fire-breathing Godzillas.

The skill required to carry out attacks on this scale has convinced United States government officials and security researchers that they are the work of Iran, most likely in retaliation for economic sanctions and online attacks by the United States.

“There is no doubt within the U.S. government that Iran is behind these attacks,” said James A. Lewis, a former official in the State and Commerce Departments and a computer security expert at the Center for Strategic and International Studies in Washington.

Mr. Lewis said the amount of traffic flooding American banking sites was “multiple times” the amount that Russia directed at Estonia in a monthlong online assault in 2007 that nearly crippled the Baltic nation.

American officials have not offered any technical evidence to back up their claims, but computer security experts say the recent attacks showed a level of sophistication far beyond that of amateur hackers. Also, the hackers chose to pursue disruption, not money: another earmark of state-sponsored attacks, the experts said.

“The scale, the scope and the effectiveness of these attacks have been unprecedented,” said Carl Herberger, vice president of security solutions at Radware, a security firm that has been investigating the attacks on behalf of banks and cloud service providers. “There have never been this many financial institutions under this much duress.”

Since September, intruders have caused major disruptions to the online banking sites of Bank of America, Citigroup, Wells Fargo, U.S. Bancorp, PNC, Capital One, Fifth Third Bank, BB&T and HSBC.

They employed DDoS attacks, or distributed denial of service attacks, named because hackers deny customers service by directing large volumes of traffic to a site until it collapses. No bank accounts were breached and no customers’ money was taken.

By using data centers, the attackers are simply keeping up with the times. Companies and consumers are increasingly conducting their business over large-scale “clouds” of hundreds, even thousands, of networked computer servers.

These clouds are run by Amazon and Google, but also by many smaller players who commonly rent them to other companies. It appears the hackers remotely hijacked some of these clouds and used the computing power to take down American banking sites.

“There’s a sense now that attackers are crafting their own private clouds,” either by creating networks of individual machines or by stealing resources wholesale from poorly maintained corporate clouds, said John Kindervag, an analyst at Forrester Research.

How, exactly, attackers are hijacking data centers is still a mystery. Making matters more complex, they have simultaneously introduced another weapon: encrypted DDoS attacks.

Banks encrypt customers’ online transactions for security, but the encryption process consumes system resources. By flooding banking sites with encryption requests, attackers can further slow or cripple sites with fewer requests.

A hacker group calling itself Izz ad-Din al-Qassam Cyber Fighters has claimed in online posts that it was responsible for the attacks.

The group said it attacked the banks in retaliation for an anti-Islam video that mocked the Prophet Muhammad, and pledged to continue its campaign until the video was scrubbed from the Internet. It called the campaign Operation Ababil, a reference to a story in the Koran in which Allah sends swallows to defeat an army of elephants dispatched by the king of Yemen to attack Mecca in A.D. 571.

But American intelligence officials say the group is actually a cover for Iran. They claim Iran is waging the attacks in retaliation for Western economic sanctions and for a series of cyberattacks on its own systems. In the last three years, three sophisticated computer viruses — called Flame, Duqu and Stuxnet — have hit computers in Iran. The New York Times reported last year that the United States, together with Israel, was responsible for Stuxnet, the virus used to destroy centrifuges in an Iranian nuclear facility in 2010.

“It’s a bit of a grudge match,” said Mr. Lewis of the Center for Strategic and International Studies.

Read More..

Online Banking Attacks Were Work of Iran, U.S. Officials Say

SAN FRANCISCO — The attackers hit one American bank after the next. As in so many previous attacks, dozens of online banking sites slowed, hiccupped or ground to a halt before recovering several minutes later.

Daniel Rosenbaum for The New York Times

James A. Lewis of the Center for Strategic and International Studies in Washington believes that recent online attacks on American banks have been the work of Iran.

But there was something disturbingly different about the wave of online attacks on American banks in recent weeks. Security researchers say that instead of exploiting individual computers, the attackers engineered networks of computers in data centers, transforming the online equivalent of a few yapping Chihuahuas into a pack of fire-breathing Godzillas.

The skill required to carry out attacks on this scale has convinced United States government officials and security researchers that they are the work of Iran, most likely in retaliation for economic sanctions and online attacks by the United States.

“There is no doubt within the U.S. government that Iran is behind these attacks,” said James A. Lewis, a former official in the State and Commerce Departments and a computer security expert at the Center for Strategic and International Studies in Washington.

Mr. Lewis said the amount of traffic flooding American banking sites was “multiple times” the amount that Russia directed at Estonia in a monthlong online assault in 2007 that nearly crippled the Baltic nation.

American officials have not offered any technical evidence to back up their claims, but computer security experts say the recent attacks showed a level of sophistication far beyond that of amateur hackers. Also, the hackers chose to pursue disruption, not money: another earmark of state-sponsored attacks, the experts said.

“The scale, the scope and the effectiveness of these attacks have been unprecedented,” said Carl Herberger, vice president of security solutions at Radware, a security firm that has been investigating the attacks on behalf of banks and cloud service providers. “There have never been this many financial institutions under this much duress.”

Since September, intruders have caused major disruptions to the online banking sites of Bank of America, Citigroup, Wells Fargo, U.S. Bancorp, PNC, Capital One, Fifth Third Bank, BB&T and HSBC.

They employed DDoS attacks, or distributed denial of service attacks, named because hackers deny customers service by directing large volumes of traffic to a site until it collapses. No bank accounts were breached and no customers’ money was taken.

By using data centers, the attackers are simply keeping up with the times. Companies and consumers are increasingly conducting their business over large-scale “clouds” of hundreds, even thousands, of networked computer servers.

These clouds are run by Amazon and Google, but also by many smaller players who commonly rent them to other companies. It appears the hackers remotely hijacked some of these clouds and used the computing power to take down American banking sites.

“There’s a sense now that attackers are crafting their own private clouds,” either by creating networks of individual machines or by stealing resources wholesale from poorly maintained corporate clouds, said John Kindervag, an analyst at Forrester Research.

How, exactly, attackers are hijacking data centers is still a mystery. Making matters more complex, they have simultaneously introduced another weapon: encrypted DDoS attacks.

Banks encrypt customers’ online transactions for security, but the encryption process consumes system resources. By flooding banking sites with encryption requests, attackers can further slow or cripple sites with fewer requests.

A hacker group calling itself Izz ad-Din al-Qassam Cyber Fighters has claimed in online posts that it was responsible for the attacks.

The group said it attacked the banks in retaliation for an anti-Islam video that mocked the Prophet Muhammad, and pledged to continue its campaign until the video was scrubbed from the Internet. It called the campaign Operation Ababil, a reference to a story in the Koran in which Allah sends swallows to defeat an army of elephants dispatched by the king of Yemen to attack Mecca in A.D. 571.

But American intelligence officials say the group is actually a cover for Iran. They claim Iran is waging the attacks in retaliation for Western economic sanctions and for a series of cyberattacks on its own systems. In the last three years, three sophisticated computer viruses — called Flame, Duqu and Stuxnet — have hit computers in Iran. The New York Times reported last year that the United States, together with Israel, was responsible for Stuxnet, the virus used to destroy centrifuges in an Iranian nuclear facility in 2010.

“It’s a bit of a grudge match,” said Mr. Lewis of the Center for Strategic and International Studies.

Read More..

DealBook: In Deal, Bank of America Extends Retreat From Mortgages

Correction Appended

9:00 p.m. | Updated

Bank of America is continuing a large-scale retreat from its costly expansion into the home mortgage market, a shift that concentrates more power in the hands of its biggest rivals and leaves fewer options for some home buyers.

The bank, which already has sharply scaled back in making mortgages, on Monday sold off about 20 percent of its loan servicing business as part of its agreement to pay the housing finance giant Fannie Mae more than $11 billion to settle a bitter dispute over bad mortgages.

The payment resolves claims that Bank of America made bad mortgages before the financial crisis that home buyers had a hard time repaying, and then sold those troubled mortgages to the government. When borrowers defaulted — sometimes within months of taking out a mortgage — the taxpayer-supported Fannie Mae suffered immense losses.

Less competition in the mortgage market could hurt consumers, potentially raising the costs of borrowing. The problems at Bank of America have cut down its mortgage ambitions; it accounts for 4 percent of the nation’s mortgage market, a slide from just over 20 percent in 2009, ceding market dominance to Wells Fargo and JPMorgan Chase.

“This is part of a broader consolidation of banks and that is something that we should all be very, very concerned about,” said Ira Rheingold, executive director of the National Association of Consumer Advocates. “Anything that leads to less competition can only be bad for consumers.”

Also Monday, Bank of America and nine other lenders agreed to an $8.5 billion settlement with banking regulators to resolve claims of foreclosure abuses that included flawed paperwork and bungled loan modifications. While the two agreements were separate, they represented one of the biggest single days for government settlements with United States banks, totaling $20.15 billion, and illustrated the extent of the banks’ role in the excesses of the credit boom, from the making of loans to the seizure of homes.

While costly, analysts said, the settlements may reduce legal uncertainties for lenders and spur more banks to compete for home loan business.

In its agreement with Fannie Mae, which the government controls, Bank of America will pay the agency about $3.6 billion to compensate for faulty mortgages and $6.75 billion to buy back mortgages that could have resulted in future losses for the government. The bank also agreed to sell to other firms the right to collect payments on $306 billion worth of home loans.

“Bank of America is sending a clear message that the bank only wants to be the mortgage lender to a select, small group of people,” said Glenn Schorr, an analyst with Nomura.

Bank of America has been battered by a steady stream of losses after its 2008 purchase of Countrywide Financial, the subprime lender that has come to symbolize the reckless lending practices of the real estate bubble. Before Monday, the $4 billion Countrywide acquisition had cost Bank of America more than $40 billion in losses on real estate, legal costs and settlements. Most of the loans covered in the Fannie Mae settlement were issued by Countrywide from 2000 to 2008.

“These agreements are a significant step in resolving our remaining legacy mortgage issues, further streamlining and simplifying the company and reducing expenses over time,” the bank’s chief executive, Brian T. Moynihan, said in a statement.

Bank of America said it expected the settlement to depress its fourth-quarter earnings by $2.5 billion. Its shares, which doubled in 2012, on Monday essentially closed flat at just over $12.

While the settlement will resolve all of the lender’s disputes with Fannie Mae, which weighed on the bank, Bank of America still faces billions of dollars in claims from investors and federal prosecutors.

While the mortgage market is consolidating in the hands of a small number of banks, the housing market is showing signs of recovery. The Federal Reserve has spent hundreds of billions of dollars to stimulate the economy, driving down interest rates on 30-year mortgages to 3.34 percent. In the last year, this has helped lift house prices from their lows and prompted a boom in refinancings. At the same time, though, even borrowers with strong credit complain about onerous checks and backlogs in the application process. This suggests banks are still struggling to efficiently follow the higher standards introduced since the financial crisis.

Nearly all mortgages that banks make right now are transferred to the government, which guarantees that they will be repaid.

Most analysts agree that mortgage rates would be lower if banks were competing more vigorously for business. Because the settlements could ease legal uncertainties surrounding mortgage lending, a wider array of banks might be encouraged to lend more, eating into the market share of giants like Wells Fargo.

“Every one of these puts a little more distance between the banks and their subprime problems,” said Guy Cecala, publisher of Inside Mortgage Finance, an industry publication.

Wells Fargo made 30 percent of all new mortgages in the first nine months of 2012, far ahead of the second-place JPMorgan, which accounted for 10 percent of the market, according to figures from Inside Mortgage Finance. In 2007, Wells Fargo originated 11 percent of new mortgages.

“The markets are actually more competitive than ever,” said Vickee Adams, a spokeswoman for Wells Fargo Home Mortgage. She says smaller banks are making gains in some of the nation’s biggest urban markets.

Some mortgage analysts said the settlements did not provide the level of legal clarity that the banks crave. “We haven’t done enough listening to the banks,” said Christopher J. Mayer, a professor at Columbia Business School. For instance, he says, the banks need clearer rules on when they have to take back loans they have sold to government housing entities.

But a big problem may be that many banks are too poorly run to compete, a situation that may not quickly change even with greater legal clarity. Bank of America’s servicing operations have struggled for several years.

“It may be that Bank of America decided that it wasn’t good enough at servicing,” said Thomas Lawler, a former chief economist of Fannie Mae and founder of Lawler Economic and Housing Consulting, a housing analysis firm.

The bank is looking to refocus beyond the mortgage business. To that end, Bank of America agreed to offload the servicing rights on two million loans with an outstanding principal of $306 billion. Those rights were scooped up by specialty mortgage servicing firms, including Nationstar Mortgage Holdings and the Newcastle Investment Corporation, which collect payments from borrowers.

Jerry Dubrowski, a spokesman for Bank of America, said, “The strategy is simple: to focus on our core retail customers, to be able to provide an entire array of products and services to them, in which mortgage is an integral product, but not the only product.”

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Correction: January 8, 2013

An earlier version of this article omitted one element of the settlement between Bank of America and Fannie Mae, and summaries of the article in some sections of nytimes.com consequently understated the total amount of the two mortgage-related settlements announced Monday. It is more than $20 billion, not $18.5 billion.

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The New Old Age Blog: Who Should Receive Organ Transplants?

Joe Gammalo had been contending with pulmonary fibrosis, a scarring of the lungs, for more than a decade when he came to the Cleveland Clinic in 2008 seeking a lung transplant.

“It had gotten to the point where I was on oxygen all the time and in a wheelchair,” he told me in an interview. “I didn’t expect to live.”

Lung transplants are a dicey proposition, involving a huge surgical procedure, arduous follow-up, the lifelong use of potent immunosuppressive drugs and high rates of serious side effects. “It’s not like taking out an appendix,” said Dr. Marie Budev, the medical director of the clinic’s lung transplant program.

Only 50 to 57 percent of all recipients live for five years, she noted, and they will still die of their disease. But there’s no other treatment for pulmonary fibrosis.

Some medical centers would have turned Mr. Gammalo away. Because survival rates are even lower for older patients, guidelines from the International Society for Heart and Lung Transplantation caution against lung transplants for those over 65, though they set no age limit.

But “we are known as an aggressive, high-risk center,” said Dr. Budev. So Mr. Gammalo was 66 when he received a lung; his newly found buddy, Clyde Conn, who received the other lung from the same donor, was 69.

You can’t mistake the trend: A graying population and revised policies determining who gets priority for donated organs, have led to a rising proportion of older adults receiving transplants.

My colleague Judith Graham has reported on the increase in heart transplants, but the pattern extends to other organs, too.

The number of kidney transplants performed annually on adults over 65 tripled between 1998 and last year, according to data from the Scientific Registry of Transplant Recipients. In 2001, 7.4 percent of liver transplant recipients were over 65; last year, that rose to 13 percent.

The rise in elderly lung transplant candidates is particularly dramatic because, since 2005, a “lung allocation score” puts those at the highest mortality risk, rather than those who’ve waited longest, at the top of the list.

In 2001, about 3 percent of those on the wait list and of those transplanted were over 65; last year, older patients represented almost 18 percent of wait-listed candidates and more than a quarter of transplant recipients. (Medicare pays for the surgery, though patients face co-pays and considerable out-of-pocket costs, including for drugs and travel.)

The debate has grown, too: When the number of adults awaiting transplants keeps growing, but organ donations stay flat, is it desirable or even ethical that an increasing proportion of recipients are elderly?

Dr. Budev, who estimated that a third of her program’s patients are over 65, votes yes. As long as a program selects candidates carefully, “how can you deny them a therapy?” she asked. So the Cleveland Clinic has no age limit. “We feel that everyone should have a chance.”

At the University of Michigan, by contrast, the age limit remains 65, though Dr. Kevin Chan, the transplant program’s medical director, acknowledged that some fit older patients get transplanted.

“You can talk about this all day — it’s a tough one,” Dr. Chan said. Younger recipients have greater physiologic reserve to aid in the arduous recovery; older ones face higher risk of subsequent kidney failure, stroke, diabetes and other diseases, and, of course, their lifespans are shorter to begin with.

Donated lungs, fragile and prone to injury, are a particularly scarce commodity. Last year, surgeons performed 16,055 kidney transplants, 5,805 liver transplants and 1,949 heart transplants. Only1,830 patients received lung transplants.

“What if there’s a 35-year-old on a ventilator who needs the lung just as much?” Dr. Chan said. “Why should a 72-year-old possibly take away a lung from a 35-year-old?” Yet, he acknowledged, “it’s easy to look at the statistics and say, ‘Give the lungs to younger patients.’ At the bedside, when you meet this patient and family, it’s a lot different.”

These questions about who deserves scarce resources — those most likely to die without them? or those most likely to live longer with them? — will persist as the population ages. They’re also likely to arise when the International Society for Heart and Lung Transplantation begins working towards revised guidelines this spring. (I’d also like to hear your take, below.)

Lots of 65- and 75-year-olds are very healthy. Yet transplants themselves can cause harm and there’s no backup, like dialysis. Without the transplant, they die. But when the transplant goes wrong, they also die.

More than four years post-transplant, the Cleveland Clinic’s “lung brothers” are success stories. Mr. Conn, who lives near Dayton, Ohio, can’t walk very far or lift more than 10 pounds, but he works part time as a real-estate appraiser and enjoys cruises with his wife.

Mr. Gammalo, a onetime musician, has developed diabetes, like nearly half of all lung recipients. But he went onstage a few weeks back to sing “Don’t Be Cruel” with his son’s rock band, “a highlight of both our lives,” he said.

Yet when I asked Mr. Conn, now 73, how he felt about having priority over a younger but healthier person, he paused. “It’s a good question,” he said, to which he had no answer.

---

Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”

Read More..

The New Old Age Blog: Who Should Receive Organ Transplants?

Joe Gammalo had been contending with pulmonary fibrosis, a scarring of the lungs, for more than a decade when he came to the Cleveland Clinic in 2008 seeking a lung transplant.

“It had gotten to the point where I was on oxygen all the time and in a wheelchair,” he told me in an interview. “I didn’t expect to live.”

Lung transplants are a dicey proposition, involving a huge surgical procedure, arduous follow-up, the lifelong use of potent immunosuppressive drugs and high rates of serious side effects. “It’s not like taking out an appendix,” said Dr. Marie Budev, the medical director of the clinic’s lung transplant program.

Only 50 to 57 percent of all recipients live for five years, she noted, and they will still die of their disease. But there’s no other treatment for pulmonary fibrosis.

Some medical centers would have turned Mr. Gammalo away. Because survival rates are even lower for older patients, guidelines from the International Society for Heart and Lung Transplantation caution against lung transplants for those over 65, though they set no age limit.

But “we are known as an aggressive, high-risk center,” said Dr. Budev. So Mr. Gammalo was 66 when he received a lung; his newly found buddy, Clyde Conn, who received the other lung from the same donor, was 69.

You can’t mistake the trend: A graying population and revised policies determining who gets priority for donated organs, have led to a rising proportion of older adults receiving transplants.

My colleague Judith Graham has reported on the increase in heart transplants, but the pattern extends to other organs, too.

The number of kidney transplants performed annually on adults over 65 tripled between 1998 and last year, according to data from the Scientific Registry of Transplant Recipients. In 2001, 7.4 percent of liver transplant recipients were over 65; last year, that rose to 13 percent.

The rise in elderly lung transplant candidates is particularly dramatic because, since 2005, a “lung allocation score” puts those at the highest mortality risk, rather than those who’ve waited longest, at the top of the list.

In 2001, about 3 percent of those on the wait list and of those transplanted were over 65; last year, older patients represented almost 18 percent of wait-listed candidates and more than a quarter of transplant recipients. (Medicare pays for the surgery, though patients face co-pays and considerable out-of-pocket costs, including for drugs and travel.)

The debate has grown, too: When the number of adults awaiting transplants keeps growing, but organ donations stay flat, is it desirable or even ethical that an increasing proportion of recipients are elderly?

Dr. Budev, who estimated that a third of her program’s patients are over 65, votes yes. As long as a program selects candidates carefully, “how can you deny them a therapy?” she asked. So the Cleveland Clinic has no age limit. “We feel that everyone should have a chance.”

At the University of Michigan, by contrast, the age limit remains 65, though Dr. Kevin Chan, the transplant program’s medical director, acknowledged that some fit older patients get transplanted.

“You can talk about this all day — it’s a tough one,” Dr. Chan said. Younger recipients have greater physiologic reserve to aid in the arduous recovery; older ones face higher risk of subsequent kidney failure, stroke, diabetes and other diseases, and, of course, their lifespans are shorter to begin with.

Donated lungs, fragile and prone to injury, are a particularly scarce commodity. Last year, surgeons performed 16,055 kidney transplants, 5,805 liver transplants and 1,949 heart transplants. Only1,830 patients received lung transplants.

“What if there’s a 35-year-old on a ventilator who needs the lung just as much?” Dr. Chan said. “Why should a 72-year-old possibly take away a lung from a 35-year-old?” Yet, he acknowledged, “it’s easy to look at the statistics and say, ‘Give the lungs to younger patients.’ At the bedside, when you meet this patient and family, it’s a lot different.”

These questions about who deserves scarce resources — those most likely to die without them? or those most likely to live longer with them? — will persist as the population ages. They’re also likely to arise when the International Society for Heart and Lung Transplantation begins working towards revised guidelines this spring. (I’d also like to hear your take, below.)

Lots of 65- and 75-year-olds are very healthy. Yet transplants themselves can cause harm and there’s no backup, like dialysis. Without the transplant, they die. But when the transplant goes wrong, they also die.

More than four years post-transplant, the Cleveland Clinic’s “lung brothers” are success stories. Mr. Conn, who lives near Dayton, Ohio, can’t walk very far or lift more than 10 pounds, but he works part time as a real-estate appraiser and enjoys cruises with his wife.

Mr. Gammalo, a onetime musician, has developed diabetes, like nearly half of all lung recipients. But he went onstage a few weeks back to sing “Don’t Be Cruel” with his son’s rock band, “a highlight of both our lives,” he said.

Yet when I asked Mr. Conn, now 73, how he felt about having priority over a younger but healthier person, he paused. “It’s a good question,” he said, to which he had no answer.

---

Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”

Read More..

Mobile Apps Drive Rapid Changes in Search Technology

SAN FRANCISCO — When the Federal Trade Commission decided last week to close its antitrust investigation of Google without charges, one important factor, though hardly mentioned, was just beneath the surface: the mobile revolution.

Google has repeatedly made the argument — and the commission agreed — that the speed of change in the technology industry made it impossible for regulators to impose restrictions without stalling future innovations.

Exhibit A is the mobile device. Nowhere has technology changed as rapidly and consumer behavior as broadly. As people abandon desktop computers for mobile ones, existing tech companies’ business models are being upended and new companies are blooming.

“Mobile is very much a moving target,” said Herbert Hovenkamp, a professor of antitrust law at the University of Iowa who has been a paid adviser to Google. “This is a market in which new competitors come in a week’s time.”

When the commission began its investigation 19 months ago, for instance, the iPhone did not have the Siri voice search, Apple did not have its own mapping service and Yelp’s mobile apps had no ads. By the time the inquiry concluded, all of that had changed. Google had new competitors on all sides trying to chip away at its hold on the mobile search and advertising market.

Still, Google is even more dominant on mobile phones than on desktop computers. It has 96 percent of the world’s mobile search market, according to StatCounter, which tracks Web use. It collects 57 percent of mobile ad revenue in the United States, while Facebook, its nearest competitor, gets just 9 percent, according to eMarketer.

But, analysts say, as people change their search habits on mobile devices — bypassing Google to go straight to apps like Yelp’s, for example — that dominance could wane, or a competitor could swoop in and knock Google off its perch.

“It’s important to recognize that many mobile apps are really vertical search engines,” said Rebecca Lieb, a digital media analyst at the Altimeter Group. “It is impossible to really say anyone dominates a section of mobile in a secure way right now.”

On cellphones or tablets, for instance, people increasingly skip Google altogether in favor of apps like Flixster for movie times or Kayak for flights.

Apple is taking on mobile search with Siri on the iPhone, which can answer questions about the weather or search for nearby restaurants. With its new mapping service, Apple has also entered local search.

On Friday, Blekko, a search start-up, introduced an app called Izik for Apple and Android devices. It tries to make searching more tablet-friendly by showing images instead of just links, and making it easier to swipe through many pages of results with a finger.

On mobile devices, said Rich Skrenta, chief executive of Blekko, “the user experience is so different that we think it opens things up. On your desktop, if it doesn’t look like Google, you think that’s not a search engine. On a tablet, it’s just vastly different.”

Jon Leibowitz, chairman of the F.T.C., said at a news conference Thursday that the speed of change in the tech industry meant that “you want to be careful before you apply sanctions.”

The commission also considered Google’s partnerships with cellphone makers like Samsung and HTC that license Google search on phones, so that a search box shows up on the home screen. In the end it decided not to take action against Google.

Some Google critics said that even though the competitive landscape is different on mobile devices, it should not have influenced the government’s analysis of Google’s behavior on the desktop Web.

“There’s no doubt that mobile applications, including Yelp’s, give consumers the ability to bypass the major search engines and go directly to the best provider of the service they’re looking for,” said Vince Sollitto, vice president for government relations at Yelp. Still, he added, “I don’t see how that impacts how someone is acting anticompetitively on the desktop.”

(One of Google’s concessions to the federal agency, that it would allow other Web companies to ask Google not to show their content in its own vertical search products — a chief complaint of Yelp’s — applies to mobile as well.)

But others said antitrust enforcement in the 21st century needs to be more agile.

Nick Wingfield contributed reporting from Seattle.

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Chemical Weapons Showdown With Syria Led to Rare Accord

Muzaffar Salman/Reuters

The violence in Syria continued on Monday. Above, Syrians went to the aid of a man who was wounded when a missile hit the al-Mashhad district of Aleppo.

WASHINGTON — In the last days of November, Israel’s top military commanders called the Pentagon to discuss troubling intelligence that was showing up on satellite imagery: Syrian troops appeared to be mixing chemicals at two storage sites, probably the deadly nerve gas sarin, and filling dozens of 500-pounds bombs that could be loaded on airplanes.

Within hours President Obama was notified, and the alarm grew over the weekend, as the munitions were loaded onto vehicles near Syrian air bases. In briefings, administration officials were told that if Syria’s increasingly desperate president, Bashar al-Assad, ordered the weapons to be used, they could be airborne in less than two hours — too fast for the United States to act, in all likelihood.

What followed next, officials said, was a remarkable show of international cooperation over a civil war in which the United States, Arab states, Russia and China have almost never agreed on a common course of action.

The combination of a public warning by Mr. Obama and more sharply worded private messages sent to the Syrian leader and his military commanders through Russia and others, including Iraq, Turkey and possibly Jordan, stopped the chemical mixing and the bomb preparation. A week later Defense Secretary Leon E. Panetta said the worst fears were over — for the time being.

But concern remains that Mr. Assad could now use the weapons produced that week at any moment. American and European officials say that while a crisis was averted in that week from late November to early December, they are by no means resting easy.

“I think the Russians understood this is the one thing that could get us to intervene in the war,” one senior defense official said last week. “What Assad understood, and whether that understanding changes if he gets cornered in the next few months, that’s anyone’s guess.”

While chemical weapons are technically considered a “weapon of mass destruction” — along with biological and nuclear weapons — in fact they are hard to use and hard to deliver. Whether an attack is effective can depend on the winds and the terrain. Sometimes attacks are hard to detect, even after the fact. Syrian forces could employ them in a village or a neighborhood, some officials say, and it would take time for the outside world to know.

But the scare a month ago has renewed debate about whether the West should help the Syrian opposition destroy Mr. Assad’s air force, which he would need to deliver those 500-pound bombs.

The chemical munitions are still in storage areas that are near or on Syrian air bases, ready for deployment on short notice, officials said.

The Obama administration and other governments have said little in public about the chemical weapons movements, in part because of concern about compromising sources of intelligence about the activities of Mr. Assad’s forces. This account is based on interviews with more than half a dozen military, intelligence and diplomatic officials, all of whom spoke on the condition of anonymity because of the intelligence matters involved.

The head of Germany’s foreign intelligence service, the BND, warned in a confidential assessment last month that the weapons could now be deployed four to six hours after orders were issued, and that Mr. Assad had a special adviser at his side who oversaw control of the weapons, the German newsmagazine Der Spiegel reported. Some American and other allied officials, however, said in interviews that the sarin-laden bombs could be loaded on planes and airborne in less than two hours.

“Let’s just say right now, it would be a relatively easy thing to load this quickly onto aircraft,” said one Western diplomat.

How the United States and Israel, along with Arab states, would respond remains a mystery. American and allied officials have talked vaguely of having developed “contingency plans” in case they decided to intervene in an effort to neutralize the chemical weapons, a task that the Pentagon estimates would require upward of 75,000 troops. But there have been no evident signs of preparations for any such effort.

The United States military has quietly sent a task force of more than 150 planners and other specialists to Jordan to help the armed forces there, among other things, prepare for the possibility that Syria will lose control of its chemical weapons.

Israel’s prime minister, Benjamin Netanyahu, was reported to have traveled to Jordan in recent weeks, and the Israeli news media have said the topic of discussion was how to deal with Syrian weapons if it appeared that they could be transferred to Lebanon, where Hezbollah could lob them over the border to Israel. But the plans, to the extent they exist, remain secret.

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DealBook: After Madoff, Financial Fraud Defies Policing

LOS ANGELES — To Philip Horn, the Braemar Country Club was not just a golf course, it was an extension of his office. Most weeks, Mr. Horn, a financial adviser at Wells Fargo, chatted up potential clients between holes at the upscale club set against the backdrop of the Santa Monica Mountains.

“I always thought, ‘This is a great guy and a straight shooter,’ ” said Barry Zelner, one of several country club members who invested with Mr. Horn.

Now, those same clients are wondering what went wrong.

After Wells Fargo alerted him to account discrepancies, Mr. Zelner, a corporate lawyer, said he stormed onto the club’s rolling greens in April, accusing the broker of theft. “Tell them what you did, Phil,” the lawyer bellowed among a crowd of members.

A few months later, Mr. Horn pleaded guilty to defrauding more than a dozen clients and Wells Fargo.

While Mr. Horn is a relatively minor player in the pantheon of financial fraud, his actions highlight the persistent problems with policing the industry, even after the wave of rules enacted since the collapse of Bernard L. Madoff’s giant Ponzi scheme in 2008.

And the challenge of oversight is not becoming any easier, with the ranks of financial advisers swelling. As new regulations crimp profits, big banks like Wells Fargo are ramping up their brokerage businesses in an effort to make up for lost revenue.

Amid the renewed focus, banks have spent millions of dollars to beef up their compliance systems and improve their oversight. Regulators, too, have bolstered their efforts, increasing enforcement and adopting new measures.

Every month, the Financial Industry Regulatory Authority, a Wall Street watchdog, penalizes more than 100 brokers for various actions, including unauthorized trading and fraudulent activities, as well as smaller violations.

“Theft, Ponzi schemes and other financial scams continue to happen at an alarming rate,” said Thomas Ajamie, a plaintiff’s lawyer who represents two of Mr. Horn’s clients.

For more than two years, Mr. Horn systematically executed and canceled trades in clients’ portfolios, pocketing the profits. To avoid detection, he limited his paper trail and made it appear that the trades originated in his own account, according to court documents.

“It’s simply unbelievable to me that this kind of fraud could happen for so long without Wells Fargo doing anything about it,” Mr. Zelner said. After meeting Mr. Horn on the golf course, Derek Brown invested more than $10 million with him in 2006, assured by the Wells Fargo name on his business card. “This wasn’t just Schlepper & Schlepper,” Mr. Brown, a retired pharmaceutical executive, said.

A Wells Fargo spokeswoman, Raschelle Burton, said the bank discovered the problems with Mr. Horn in October 2011 and immediately alerted law enforcement agencies. Wells Fargo also fired Mr. Horn. Mr. Horn is set to be sentenced on Monday. Prosecutors have recommended an 18-month sentence. A lawyer for Mr. Horn declined to comment.

Some of Mr. Horn’s clients are struggling to understand the extent of their losses. Mr. Brown and Mr. Zelner say that Wells Fargo has not let them review the trading records. Instead, they have had to rely on the bank’s analysis. “The firm believes it has provided appropriate information,” Ms. Burton said.

Prosecutors estimate the scheme’s damages at $732,000. But there are indications the losses could be higher. Last year, Wells Fargo, without explanation, transferred roughly $500,000 to an account that Mr. Brown has at Merrill Lynch. Mr. Brown said he planned to file a lawsuit seeking additional compensation.

While some clients still have concerns, Wells Fargo said the matter had been resolved and declined to provide further details. “In cases where his actions harmed the clients, the firm has either credited those accounts or reached another resolution with those clients,” Ms. Burton said.

On paper, Mr. Horn seemed like a model broker. After a short stint at Lehman Brothers in New York, he spent a decade at Citigroup in Los Angeles, moving to Wells Fargo in 2006. For much of his career, his regulatory record was clean, with few customer complaints.

At Wells Fargo, Mr. Horn, who worked in a team of brokers, seemed to land clients without an aggressive approach. He wooed clients slowly, often over many years. Between golf holes, he would casually mention winning trades, almost as an aside.

He nurtured friendships with clients. Norman Strang, an 80-year-old retired aerospace executive, said his wife regularly cooked dinner for Mr. Horn at the couple’s home in Pacific Palisades, Calif. “Here he was being this friendly guy, and yet he stole several thousands of dollars from our account.” Mr. Horn went to the weddings of both Mr. Brown’s children and planned to join him on a charitable trip to Israel and Morocco in the fall of 2011.

In 2011, Mr. Horn invited clients to his 50th birthday party inspired by the movie “Saturday Night Fever.” The tall and lanky Mr. Horn wore a white disco suit and handed out CDs with a cover that superimposed his head onto John Travolta’s body.

Given Mr. Horn’s gregarious nature, clients say they dismissed what should have been red flags. According to Mr. Zelner, Mr. Horn avoided meeting at his office, preferring the golf course. Between games, they would meet in the country club’s parking lot, where the broker would pull trading documents from his trunk.

“Phil would present his investments as if he was giving you something that would protect you,” said Mr. Zelner, adding that “he was also just a guy you wanted to drink with.”

Many clients trusted him. Each month, they received thick booklets detailing trading activity, but few pored over the trades. “If I had time to do that, I wouldn’t need a broker,” Mr. Brown said.

Amid hundreds of legitimate transactions, a dubious trade was also hard to spot. In one instance, Mr. Horn bought 1,000 shares of an exchange-traded fund for $77.93 apiece on Feb. 15, 2011, according to Mr. Brown’s bank statements. A month later, Mr. Horn canceled the trade. By then, the price had surged to $86. But the transaction was buried within more than 50 double-sided pages. It appeared as a canceled trade, which by itself was not alarming.

Mr. Brown and his wife did not know anything was amiss until they received a startling call from an executive at Wells Fargo. While the couple were celebrating the Jewish holidays in Toronto in October 2011, the bank executive told them about the problems with their account. Mr. Brown added, “He said we had a ‘six-figure problem.’ ”

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